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Wednesday, July 10, 2019

Retrospective #144: Diabetes and Dementia

The “Background”
in the Abstract of this August 2013 piece in The Lancet states: “Although patients with Type 2 diabetes are
twice as likely to develop dementia as those without this disease, prediction
of who has the highest future risk is difficult. We therefore created and
validated a practical summary risk score that can be used to provide an
estimate of the 10-year dementia risk for individuals with Type 2 diabetes.” Diabetes in Control, a digest for
medical doctors to which I subscribe, picked it up. Have I got your attention
yet? Well, it gets much scarier.

The
researchers were from the University Medical Center Utrecht, Netherlands, the
University of Chicago, the University of Washington, and Kaiser Permanente. In
2013 Kaiser Permanente was the largest managed care organization in the U. S.,
with almost 9 million health plan members, 15k doctors, 170k employees, and $50
billion in annual revenues. Kaiser Permanente, the National Institute of
Health, and Fulbright funded the study.

The
researchers used data from patients with Type 2 diabetes, aged ≥60 years, with
10 years of follow-up. The risk factors in their analysis that were “most
strongly predictive of dementia” were “microvascular disease, diabetic foot,
cerebrovascular disease, cardiovascular disease, acute metabolic events,
depression, age, and education.”

The
outcome of their risk analysis? “The prediction of 10-year dementia risk in
patients with Type 2 diabetes mellitus “shows a 5.3% risk for the lowest score
and 73.3% for the highest score. The Diabetes
in Control piece states, “According to the authors of this study, those in
the higher risk category were 37 times more likely to develop dementia than
those in the lowest risk category.”

How
do they plan to use this information? You’ll love this. They say, “The risk
score can be used to increase vigilance for cognitive deterioration and for
selection of high-risk patients for participation in clinical trials” (my
emphasis). And that’s it! In other words, they watch as
you develop dementia, and then perhaps suggest that you sign up for a
clinical trial to test another drug to treat your cognitive
deterioration. Isn’t that just dandy!

Of
course, there is another way. Remember, the researchers who created and tested
this risk analysis prediction tool used “data from approximately 30,000 Type 2
diabetic patients aged 60 and greater over a 10-year interval.” These diabetics
were presumably being advised to eat a “one-size-fits-all” low-fat, high-carb,
restricted-calorie diet, with lots of “healthy fruits and vegetables” (all
carbohydrates) with minimum saturated fat and dietary cholesterol.

Most
were probably also medicated for hypertension (high blood pressure) and for
high cholesterol with statins.

Further,
the treatment standard that the clinicians were using was undoubtedly the one
supported by the current “Standards of Medical Care in Diabetes” published
annually in Diabetes Care, the Journal
of the American Diabetes Association. That means that your physician will be
safe-guarded from medical liability to simply advise you that your Type 2
diabetes is “under control.” He will not inform you that your elevated
blood glucose levels, as allowed by this standard, are
progressively damaging your blood vessels, organs and endocrine system.

If
you leave the care of your Type 2 diabetes in the hands of your physician, this
is what will happen to you: As he observes your A1c rise, he or she will
prescribe higher doses and more medications until you are maxed out, and then
possibly switch you to injected insulin. Repeat for your elevated cholesterol
and high blood pressure.

And
when you are unable to lose weight and keep it off on a low-fat, high-carb
diet, as he makes a note in your file that the “patient was non-compliant,” you
will be reminded again to “eat less and exercise more.”

Don’t
be a member of this treatment cohort. Take charge of your
own health. Do not accept an A1c of ≤7.0% as “in control.” At this level, your
heart attack risk is doubled. Eat a diet that is low in carbohydrates;
better yet, VERY low. Don’t sweat the saturated fat and dietary
cholesterol. Your body will love it. And so will your doctor. He
or she will be pleasantly perplexed with your lab results and weight loss, and
will almost certainly lower your meds, and then tell you to “just keep on doing
what you’re doing.” That’s an outcome you can both happily live with.

About Me

I was diagnosed a Type 2 diabetic in 1986. I started a Very Low Carb diet (Atkins Induction) in 2002 to lose weight. I didn’t realize at the time that it would put my diabetes in clinical remission, or that I would be able to give up almost all of my oral diabetes meds. I also didn’t understand that, as I lost weight and continued to eat Very Low Carb, my blood lipids would dramatically improve (doubling my HDL and cutting my triglycerides by 2/3rds) and that my blood pressure would drop from 130/90 to 110/70 on the same meds.
Over the years I changed from Atkins to the Bernstein Diet (designed for diabetics) and, altogether lost 170 pounds. I later regained some and then lost some. As long as I eat Very Low Carb, I am not hungry and I have lots of energy. And I no longer have any of the indications of Metabolic Syndrome.
My goal, as long as I have excess body fat, is to remain continuously in a ketogenic state, both for blood glucose regulation and continued weight loss. I expect that this regimen will continue to provide the benefits of reduced systemic inflammation, improved blood lipids and lower blood pressure as well.